Provider Demographics
NPI:1265471080
Name:CARLSON, POLLY THOSATH (MS)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:THOSATH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S WASHINGTON ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2604
Mailing Address - Country:US
Mailing Address - Phone:509-242-2200
Mailing Address - Fax:509-242-2202
Practice Address - Street 1:507 S WASHINGTON ST
Practice Address - Street 2:SUITE 180
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2604
Practice Address - Country:US
Practice Address - Phone:509-242-2200
Practice Address - Fax:509-242-2202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health